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Technical Document

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Getting started as a Humana Referral Specialist
Martha L. Diaz
Colorado Technical University

Executive Summary
Background:
The proper documentation of a member’s account is critical to ensure the timeliness of contact with the member to ensure that the member is receiving the best possible care from Humana. Over the last quarter we have lost 2500 member dropping out of the program due to not contacting a member in a timely fashion that either they do not feel like it would benefit them now or they simply have forgotten about the initial call detailing what the program entails for them.
Purpose:
This procedure manual will ensure to better equip new referral specialist with the essentials to ensure proper documentation of a member’s in the clinical database. It will decrease the number of errors that are done in the documentation process of documenting in the clinical database and increase the success rate of member contacts for the healthcare managers. By increasing the success rate of the members contacted it will decrease the cost of medical expenses to both the member and Humana. Errors done in the documentation process can result in a member not being contacted in a timely manner, which can delay proper healthcare options for a member or assistance that a member may be in need of. Some of the members that are on a Humana plan suffer from multiple conditions that impact the quality of life of the members that are suffering from the conditions. Conditions like Congestive Heart Failure, Diabetes, and many other life threating conditions and without proper care member could fact dangerous consequences, and delaying medical advice or treatment could result in a member making an unnecessary trip to the emergency room when they could have talked to their healthcare manager and found out that they could have schedule a visit with their primary care doctor

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